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Annual Session update

A team of three residents from McGaw Medical Center at Chicago's Northwestern University took home the prestigious ACP Osler Cup after winning this year's national Doctor's Dilemma competition at Annual Session.

The Northwestern residents bested a record number of competitors, with 23 teams of College Associates fielded by ACP chapters during the three-day competition, which is modeled on the game show Jeopardy! The Northwestern team won by providing the correct name for the the disease associated with ash leaf depigmentation. ("What is tuberous sclerosis?")

The three winning team members are Joyce S. Lee, ACP Associate, Siddharth Shah, ACP Associate, and Seth Sweetser, ACP Associate. Now in his third year, Dr. Sweetser will be chief resident next year before beginning a gastroenterology fellowship. Dr. Lee is in her second year of the Northwestern program and plans to pursue a pulmonary-critical care fellowship, while Dr. Shah, an intern, is considering a renal fellowship after residency.

This year's event differed from previous years', which were all held on one day. The 23 teams in 2005 first met for an elimination round, leaving eight teams to go head-to-head on the second day of Annual Session. On Saturday, four teams met for the semi-final, while two teams—Northwestern's and the team from the William Beaumont Army Medical Center in El Paso, Texas—entered the final round, which closed out Annual Session activities.

Doctor's Dilemma questions were prepared by Patrick C. Alguire, FACP, ACP's Director of Education and Career Development, while Steven E. Weinberger, FACP, the College's Senior Vice president for Medical Knowledge and Education, quizzed the two teams in the final round.

Medicare news

A study released last week found that high costs and concerns about drugs' effectiveness lead two out of five seniors to disregard prescriptions ordered by their physicians.

The study, sponsored by the Kaiser Family Foundation and the Commonwealth Fund, included nearly 18,000 Medicare patients, according to the April 19 USA Today. Researchers claimed the new Medicare drug benefit will address some patients' noncompliance, but said the patient-physician relationship also plays a key role.

About one-quarter of seniors surveyed said they failed to take medications because of concerns about side effects, reluctance to take multiple medications and the belief that the medicine was ineffective, USA Today reported. Study authors noted that physicians and patients should spend more time talking about how patients can afford and tolerate prescription drugs.

Similarly, about one-quarter of respondents said high costs drove them to forgo taking medications. These beneficiaries are expected to get relief from the new Medicare drug benefit, said USA Today, which could save patients with no previous drug coverage more than 50% on drug costs.

Another study published last week looked more closely at the effect of the Medicare prescription drug benefit that will take effect in January 2006. According to that research, while most seniors will benefit from the new Medicare benefit, those with chronic conditions will continue to face high costs as well as significant gaps in coverage.

Patients with chronic illnesses such as diabetes, chronic lung disease and mental illness are unlikely to get financial relief in the first year of the program, study authors said, because catastrophic coverage does not kick in until a beneficiary's total spending reaches $5,100. Under the new prescription benefit plan, a typical Medicare patient with an income 150% above the poverty line has a $250 deductible and a gap for prescription spending between $2,250 and $5,100. The study was published in the April 19 online edition of Health Affairs.

Those with higher drug bills will be hardest hit because they reach that gap sooner, according to the April 19 Washington Post. The authors projected that the average beneficiary would spend $722 annually out-of-pocket, a savings of 55% compared with having no coverage. However, those with diabetes would save 32% over no coverage with the prescription drug benefit, while those with mental illness would save only 16%.

The authors of an accompanying study in Health Affairs noted that seniors with hypertension, chronic heart and circulatory problems, and arthritis would also face higher costs under the new Medicare drug benefit and resort to cutting back on their use of medications.

Drug update

Ortho-McNeil Neurologics Inc. this month announced that it is changing the name of its Alzheimer's drug Reminyl (galantamine hydrobromide) to Razadyne to help avoid confusion with the diabetes drug Amaryl (glimepiride).

The company announced that it began working with the FDA on a name change since it received several reports about prescribing and dispensing errors, according to an April 11 company news release. Errors in prescription writing, interpreting, labeling and filling led to some Alzheimer's patients getting Amaryl. Those errors led to serious adverse events, including two deaths and several cases of severe hypoglycemia.

The newly-named Razadyne product will appear in pharmacies in mid-May for the extended release formulation and in July for the immediate release version, according to the release. The company will continue to educate physicians and pharmacists about the name change through letters, ads and brochures.

Research news

A new federal study published last week found that being overweight may confer a lower risk of early death than being thin—as long as patients don't become obese.

The study, conducted by researchers at the National Cancer Institute and the CDC, found that only the extremely obese had an increased risk of early death due to weight, according to the April 20 New York Times. In addition, those who were very thin had a slightly increased risk of early death.

The findings, published in the April 20 Journal of the American Medical Association, were based on federal weight categories and took into account the effects of smoking, age and other factors. The study, which used data from the National Health and Nutrition Examination surveys, found that extreme obesity was associated with excess deaths, but that being overweight (BMI of between 25 and less than 30) was not.

The New York Times pointed out that researchers did not address how weight affects patients' risk of developing diseases such as diabetes, high blood pressure or high cholesterol. Study authors noted, however, that modern medications have reduced the prevalence of these conditions among the obese, thus reducing their overall mortality risk.

Member news

Mark V. Shelton, FACP, a general internist in Winnfield, La., was named co-recipient of this year's Physician-Physician Assistant Partnership Award from the American Academy of Physician Assistants (AAPA).

Dr. Shelton shares the award with Tony Acosta, the physician assistant with whom he's worked at Winn Parish Medical Center for six years. According to an April 15 AAPA press release, the two worked together to expand a phase II cardiac rehabilitation facility and develop a wellness center for senior citizens.

They also improved the quality of health care in their rural community by bringing automated external defibrillators (AEDs) to emergency services in central Louisiana, educating civic leaders about AEDs and developing the AED Network, which sent more than 300 units to law enforcement and fire agencies throughout the state.

In addition, Dr. Shelton and Mr. Acosta have taught more than 3,000 high school students, local officials and other volunteers how to respond to cardiac arrests, according to the AAPA, which will present the award at its annual conference next month. Dr. Shelton and Mr. Acosta also helped develop a plan to provide low-cost prescription drugs to low-income patients who weren't eligible for Medicaid.

Alan R. Nelson, MACP, Chair of the ACP Foundation and Special Advisor to ACP's Chief Executive Officer, received the 2005 Northwestern Alumni Association Award for the School of Medicine. He received the award earlier this month in Chicago.

A former Chief Executive Officer of the American Society of Internal Medicine before its merger with ACP, Dr. Nelson has been a member of the Medicare Payment Advisory Commission (MedPAC) since 2000 and is also a member of the Institute of Medicine (IOM). He chaired an IOM committee that addressed ethnic and racial disparities and now serves on an IOM committee looking into pay-for-performance programs.

Northwestern presents its annual award to alumni for their national, professional or university contributions.

Health care access

The third annual Cover the Uninsured Week, being held this year May 1-8, will once again highlight the 45 million Americans who have no health insurance.

This national event, which is supported by ACP and sponsored by the Robert Wood Johnson Foundation, among others, helps coordinate local activities including news conferences, health and enrollment fairs, seminars for small business owners and interfaith activities. The campaign's current target markets include Albuquerque, Chicago, Denver, Detroit, Houston, Miami, Nashville, New Orleans, New York, Philadelphia, San Diego, Seattle and Tampa.

Chapter members participating in Cover the Uninsured Week activities can access a slide show assembled by the ACP's Washington office. The slides are filled with facts and figures about the uninsured and on how the problem of uninsured patients affects the entire country. ACP members interested in accessing the slide show can contact their chapter Governors.

The organizers of Cover the Uninsured Week encourage activities throughout the year and can provide assistance to local advocates. You can contact Elizabeth Prewitt or call 202-261-4540 or 800-338-2746, ex. 4540.

More information, including a map with local Cover the Uninsured Week events, is online.

ACP news

Physicians can now order booklets of ACP's "Ethics Manual, Fifth Edition," which was published earlier this month in Annals of Internal Medicine. The revised manual includes new or expanded sections on professionalism, end-of-life care, physician-assisted suicide, the physician-patient relationship and much more. A case method for ethical decision-making is included.

The "Ethics Manual" booklet is $9 for ACP members, $11 for nonmembers, and bulk discounts are available. To order, contact ACP Customer Service at 800-523-1546, ext. 2600.

ACP ObserverWeekly is a weekly newsletter produced by the staff of ACP Observer. It is automatically sent to all College members who have an e-mail address on file with ACP.

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Copyright 2005 by the American College of Physicians.

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A 54-year-old woman is evaluated for shortness of breath of 3 months' duration and a 4.5-kg (10-lb) weight loss over the preceding 2 months. She has a 35-pack-year smoking history. Following a physical exam and further testing, what is the most appropriate treatment?

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